Dementia is an illness characterized by significant impairment of one or more areas of higher cognitive functioning, such as memory or ability to calculate. Dr. Mel Daly, a geriatrician at Greater Baltimore Medical Center Greater Geriatrics Group, discusses symptoms and treatment for dementia.
* About one in five people over age 80 have some form of dementia. Close relatives of people with early onset (before age 60) Alzheimer's disease have a greater chance of getting the disease. Those with genes from a group called ApoE are at increased risk for developing Alzheimer's disease. All persons with Down syndrome will eventually get Alzheimer's if they live long enough, and about half of patients with Parkinson's disease will develop a dementia similar to Alzheimer's. Head trauma or repeated blows to the head are also risk factors.
* Chronic alcoholism often results in dementia. Persons with high blood pressure, diabetes mellitus, cigarette smokers, high cholesterol levels, and atrial fibrillation are at risk for strokes that impair higher cognitive functioning.
Dementia can occur in patients with AIDS. Rarely, dementia is caused by other infections such as tertiary syphilis and viruses (Jacob-Creutzfeld disease).
* Symptoms of dementia are varied and depend on the cause. Memory loss is most common and noticeable. In the early stages, people with Alzheimer's disease usually have preserved childhood memories and are more likely to forget recent events. They may have trouble with financial affairs, and they often are no longer capable of driving. Depression, tearfulness or outbursts of anger are common. Sleep is often impaired. Hallucinations and delusions can occur.
The diagnosis is usually considered when symptoms have been present for at least six months, and the degree of impairment is beyond what might be expected from normal aging. Symptoms that come on suddenly may suggest a vascular dementia.
* There is some evidence that dementia may be prevented or delayed by eating fish two to three times a week, eating a Mediterranean diet with olive oil, exercising three times per week, engaging in creative learning, and participating in "uplifting" group activities. If dementia is suspected, it is important that the patient is appropriately and thoroughly evaluated by a knowledgeable practitioner.
* There is no cure for dementia, but there are medications that if used early may slow progression, and in some people improve symptoms. Anti-inflammatory drugs (e.g. ibuprofen) may have a role in preventing and treating dementia. If neuropsychiatric symptoms occur, it might be necessary to treat these symptoms with major tranquilizers, anxiolytic medications, and hypnotic agents.
